Helminth-based therapies for rheumatoid arthritis: A systematic review and meta-analysis.

Abstract Objective Proteins from parasitic worms have been posed as novel therapies for rheumatoid arthritis (RA) and other auto-inflammatory diseases. However, with so many potential therapeutics, it is important that drug discovery be based on the specific phyla or species which show the most promising effects. Therefore, the aim of this systematic review and meta-analysis was to evaluate the reported effects of helminthic secretory proteins and derivative therapy on RA in an animal model. Methods Medline, Scopus and Web of Science were searched to identify studies evaluating helminthic therapy in the collagen-induced arthritis model of RA. A meta-analysis was undertaken to determine the overall effect of the proteins. Subgroup analyses were also undertaken to investigate individual treatments. Results Seven articles were included in the analysis. Overall, helminthic therapy significantly reduced arthritis score (SMD −1.193, 95% CI −1.525, −0.860). Subgroup analyses found a significant reduction in arthritis score following treatment with helminth protein ES-62 (SMD −1.186, 95% CI −1.633, −0.738) and phosphorylcholine-based treatment (SMD −0.997, 95% CI −1.423, −0.571). Subgroup analyses found ES-62 treatment significantly decreased IFN-γ levels (SMD −1.611, 95% CI −2.734, −0.487) and significantly increased levels of IL-10 (SMD 0.946, 95% CI 0.127, 1.765). Conclusions Therapeutics from parasitic worms are a promising avenue for drug discovery, especially with all included studies reporting a significant improvement in arthritis score. Based on pooled data presented in this study, the nematode Acanthocheilonema viteae seems to be of particular interest for therapeutics. Highlights • Proteins from helminths are being trialled in models of immune-mediated disease. • Treatment with helminth proteins significantly reduces rheumatoid arthritis in mice. • ES-62 treatment saw increased IL-10 and decreased IFN-γ cytokine levels. • Acanthocheilonema vitea is the subject of a notable amount of research in this area. [ABSTRACT FROM AUTHOR]